Olivia admits she’s always been a worrier – but when she started university, her anxiety steadily began to build. One day she was simply too frightened to leave the house. For two weeks she was stuck indoors, before she was diagnosed with generalised anxiety disorder and began to get the help she needed.
With support from her GP and university wellbeing service, and courses of cognitive behavioural therapy (CBT), she was able to stick with her university course and to start enjoying life again.
But Olivia is far from alone in her anxiety: the number of students declaring a mental health problem has doubled in the last five years, to at least 115,000.
“And that is a very small proportion of the students who are having mental health difficulties,” says Ruth Caleb, chair of Universities UK’s mental wellbeing working group.
A study of UK undergraduates has found that even among students symptom-free before starting university, some 20% are troubled by a clinically significant level of anxiety by the middle of second year.
What does anxiety do to students? It causes the body to prepare itself for fight or flight.
“If you are in a situation of imminent actual threat, then the increased alertness and body response can be lifesaving,” explains Chris Williams, professor of psychosocial psychiatry at the University of Glasgow, and medical advisor to Anxiety UK.
“But if it occurs when trying to revise, or present a talk, or at such a high level that it paralyses or causes errors, it can interfere with what we want to do.”
What happens in the brain of someone experiencing excessive anxiety is not fully understood. One line of research, says consultant psychiatrist Rajeev Krishnadas, is that it involves the prefrontal cortex and the amygdala – a key region of the brain involved in learning and memory, as well as in the physiological and behavioural responses to fear.
“An external stimulus – sight, hearing, touch, smell and taste – activates a number of regions of the brain, crucially including the amygdala,” says Krishnadas. Under normal circumstances, he says “the amygdala is under tight control from the prefrontal cortex, which evaluates the threat associated with the stimulus. If the stimulus is non-threatening, the activity within the amygdala is suppressed. If it is threatening, the amygdala fear response is maintained.”
In someone with an anxiety problem, it seems, the brain is making incorrect decisions about what to fear and the prefrontal cortex fails to suppress the amygdala, putting the body into fight or flight mode.
In this state, levels of the hormone adrenaline rise and the sympathetic nervous system – which controls automatic activities (like breathing) rather than conscious action – takes over. The heart rate rises, breathing speeds up and blood is diverted to the limbs, blood pressure and body temperature increase, and you may start to sweat.
This is clearly not a state conducive to learning or concentrating in a seminar, says clinical psychologist Dr Angharad Rudkin. “Even if you manage to take in what is being said, the information is likely to bounce around [in your brain], not being processed properly or stored in your long-term memory.”
10 tips for anxious students
Last month, Anxiety UK launched a student guide to anxiety. Here are Anxiety UK and Dr Rudkin’s top 10 self-help tips:
- If you feel yourself start to panic, tell yourself: don’t panic; you can do this. Self talk can reduce anxiety.
- Work on controlling your breathing. Try breathing in through your nose for four seconds, holding for two seconds, then breathing out through your mouth for six seconds.
- If you find large busy lecture rooms a problem, start by sitting near the exit. Record lectures so you can listen back to any bits you missed.
- Break coursework and essays into small chunks. This takes a bit of planning and means not leaving it all to the last minute, but it staves off anxiety.
- Most research into young people’s attention spans suggests a limit of 40 minutes, so work in half-hour chunks with short breaks between for a drink or a breath of fresh air.
- Procrastination can be the anxious person’s biggest enemy. Convince yourself to work for just five minutes. Once you’ve started you may be able to keep going. If not, at least you have achieved five minutes of work.
- Be kind to yourself – but disciplined. It is easy to become your own worst enemy. Accept that things are tough right now and think about how you can work with your brain to make things happen.
- Moderate your caffeine and alcohol intake. Excessive caffeine increases symptoms of anxiety and although alcohol is a relaxant it may not help the next day.
- Remember you are not alone. Everyone else may look as if they are coping fine but many of them are struggling too. Talk to people.
- Follow a healthy routine of eating, sleeping and exercise. Even 30 minutes walking a day can reduce anxiety. Disrupted sleeping and eating are classic accompaniments to anxiety and can create a vicious cycle. If this is happening, seek help.